2209MED

2209MED: Intervention CritiqueClayton Edwards
Griffith University
Intervention Critique: Obesity Prevention
Obesity is one of the top and concerning problem in Australia, specifically within the adult Australian people. The prevalence of obesity has evidently increased, with up to 63.4% of Australian adults classify as overweight or obese with 33.5% overweight and 27.9% obese (Australian Bureau of Statistics (ABS), 2015). This is a very concerning number that equates to at least two in three Australians adults being overweight or obese (ABS, 2015). With the rapidly growing obesity crisis, preventative measures are important implications that encourage active engagement in reducing the negative impact of obesity on the Australian population (Islam & Fitzgerald, 2016). Preventative measures are intended to help contribute to an increase in life expectancy and improve the quality of life of populations (Cyril et al., 2017). This essay will present guidelines and behaviour changing strategies, in which, will impact on behavioural changes positively which include: Health Star Rating (HSR) and A Healthy Weight Guide (AHWG). The HSR is a nutritional guideline in Australia which focussing on the whole population with better nutritional education and awareness which will promote healthier options, in which, will result in decreasing the obesity rate in the Australian population (Obesity Policy Coalition (OPC), 2018). The AHWG is a website which engages Australian people through guidance and education to help make the healthier choice and maintain healthy weight goals (Department of Health (DOH), 2014). These policies and guidelines are promoted to help in significantly reducing the obesity rate, decrease poor health habits, and bring purpose in indigenous communities (OPC, 2018; DOH, 2014). The purpose of this essay is to show positive preventative and managing measures, educational methods which will assist in positive behavioural changes for overweight and obese Australian people (DOH, 2014). It will be argued that promoting 5-star rating scaling of healthy food and drink choices, education on nutritional literacy, and changing individual lifestyles will positively impact on overweight and obese Australian people to live a healthy and active lifestyle.
Overview
The rapidly increasing obesity epidemic is caused by major nutrition transition according to studies (Méthot, & Poirier, 2010). Obesity is an abnormal physiological growth through increased adipose tissue accumulation that can result in negatively affecting health (Chan & Woo, 2010). There are two measures that help identify if an individual is overweight or obese which include: Body mass index (BMI) and various anthropometric indices such as waist-to-hip ratio, waist circumference, and waist-to-height ratio (Chan & Woo, 2010). BMI is the most notable and useful measure used to measure obesity through classifications which include: underweight, normal weight, overweight, and obese (Lavie, et al., 2014). Individuals scoring 25 – 29.9 are considered overweight, and individuals scoring over 30.0 or more are commonly referred to as obese (Méthot, & Poirier, 2010). Anthropometric indices can provide a detailed and accurate measure in distinguishing whether someone is obese or not (Sebo, Herrmann, & Haller, 2017). The two measures indicate that both are integral in identifying obesity and associated health risk factors (Chan & Woo, 2010).
There are a variety of health risk factors that negatively impact on the Australian population which include a poor diet and lack of exercise (Islam & Fitzgerald, 2016). Poor diet relates to the lack of vitamins, minerals, and increased intake of high energy dense foods, through lack of fruit and vegetable intake, and high consumption of takeaway outlet food (Satija, 2017). The lack of exercise relates to the increased sedentary lifestyle people live (Lavie, et al., 2014). For that reason these risk factors arise, preventative measures towards limiting obesity need to be undertaken to decrease the major causes of co-morbidities which include: cardiovascular disease, type II diabetes, pulmonary disease, digestive disease, disability, cancer, and mental health illnesses, all of which, can lead to further morbidity and mortality (Meleady, 2018). Obesity contributes to proliferating disease which increases the demands of more health care, which results in the economy being negatively impacted (Aitken et al., 2017). Approximately 8.6 billion dollars or seven percent of the total health care burden (Australian Institute of Health and Welfare (AIHW), 2017). These financial factors impact on variety of ways which include socially, emotionally, and psychologically in a significantly negative way (AIHW, 2017). These preventative measures are intended to help contribute to an increase in life expectancy and improved quality of life through educating people on healthy choices and increasing engagement in physical activity (Meleady, 2018).

Policy Intervention
The emphasis of high energy dense foods, nutrient void, and lack of vegetable advertisement encourages negative behaviour which equates in poor health and with poor health results in obesity (Satijta et al., 2017). This where policy intervention are crucial, because they provide information and guidelines for the population (Satijta et al., 2017). The HSR provides this necessity through a strategic movement produce by the Australian government which refers to significantly reducing health determinant such as obesity through an environmental approach by increasing assessments on food and diet related conditions (OPC, 2018). The consumption of processed food with extremely high energy density is the major cause of obesity (Temple et al., 2017). When over consumption of high energy dense snacking foods is replaced with low energy density foods, a significant decrease in waist circumference and adipose tissue in shown (Temple et al., 2017). The HSR follows a similar process through education and providing up close information for Australian consumers through the front of food packaging labels (OPC, 2018). The HSR purpose is to educate and monitor behaviours of food purchases through a 5-star rating scale to encourage healthier options towards the HSR framework (OPC, 2018). The HSR has a variety of objectives it aims to achieve which include: understanding which is the individuals the purpose of the HSR, usage which is how individuals see the HSR is used, consideration which considers identify triggers and barriers for individuals, and optimisation which is an objective to provide confidence and knowledge towards the HSR for individuals (OPC, 2016). This model is backed by research suggesting providing nutritional information on the packet of foods will encourage individuals to make an informed decision (Satijta et al., 2017). The HSR is aimed to increase life expectancy and healthy living throughout the Australian population with the purpose focussing on areas that were of major concern which include nutritional awareness (OPC, 2018). HSR is also focussed on changing the socioeconomic climate as well as addressing improving individual behaviour changes which recognises healthy diet will improve health, in which, results in helping the most disadvantaged population group through education and guidance to live a healthier life (OPC, 2018).

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According to (DOH, 2014), obesity and the various co-morbidities associated were major leading contributors to poor health with 13%, which the HSR has shown positive engagement in the Australian population with the HSR with 52% of consumers responding positively to the HSR system (OPC, 2018). Further improvement of the HSR will see positive feedback from consumers (OPC, 2018). The HRS has created a notable behaviour change which shows at least 16% of individuals using the HSR system made changes to a solid healthy choice on the food they purchase based on the rating system (OPC, 2018). The influence of the rating scale suggests information about products give individuals valuable data in making a decision, in which, created a change in the environment that resulted in purchasing a healthier food (OPC, 2018). There are a few limitations with the HSR framework which include the inconsistency of the 5-star rating scale, not based on current recommended intakes, not based on for all people, use of adult recommendations on child products, and do not provide interpretive guidance (OPC, 2018). The Australian population showed only 52% understood the HSR system which provides information that the HSR is working, which suggests front labelling foods is not as effective for guiding Australian population. Individuals that require literacy support or individuals living in disadvantaged circumstances such as low socio-economic background, have found the HSR difficult to interpret, in which, results in confusion (OPC, 2018). Dietary guidelines such as the HSR need regular updating and current evidence backing the guidelines for it to be followed (Satijta et al., 2017), which underlines the limitation on having child food recommendation as adult nutritional. Therefore, long term sustainability is unknown without necessary changes to current policy.
Behaviour change intervention.

Interventions that promote positive behaviour change are crucial in educating individuals. The AHWG website provides this necessity through an interactive educational resourceful website for people looking for education on how to make healthy choices, which include: finding resources, supporting literature, and providing proven guidelines to follow in achieving healthy weight and life (DOH, 2014). The AHWG website was developed to enable Australian people to set realistic and achievable goals towards healthy living through planning a sound nutrition and exercise program (DOH, 2014). Throughout the program, the interactive website allows for Australian people to monitor and analyse what challenges are needed to be done through downloading forms to fill out, and supportive resources in achieving a healthy weight with the aim of assisting Australian people (DOH, 2014). The information provided by the AHWG website is relevant to obese and overweight people to engage in a more active life (DOH, 2014).
There are many benefits from an interactive website which include: providing plenty of valuable information on tips to become healthy and active, setting out an achievable weight, and proving support with overcoming challenges (Satija, 2017). Research suggest providing the public with necessary information on major health priorities such as obesity can see a positive impact on health (Swinburn, 2013). The AHWG provides this necessity through interactive avenues throughout the website with exercise programs, and diet journals (DOH, 2014).
Behavioural change is critical with the prevalence of obesity. There are growing concerns as obesity correlating to binge eating disorders through the exposure of high energy dense foods (Russo et al., 2011). Encouraging people to modify and self-regulate behaviours individually and encouraging individuals to seek necessary guidance through professional advisement to identify and assess problems that appear challenging to an individual will result in a positive behavioural changes significantly (Russo et al., 2011). However, obesity presents itself as a complex and difficult process to overcome, research has consider sedentary lifestyles behaviours and poor nutritional literacy are main concerns in the increase of obesity cases (Satija, 2017). Despite the AHWG interactive website providing a significant detailed explanation on how to make healthier choices, research suggests that, individuals will only seek this guidance if intrinsic motivation is present (Russo et al., 2011). This provides an obstacle for behaviour changing interventions, because of individual motivation being a critical drive in behaviour change (Satija et al., 2017).

Summary of critique
The HSR and AHWG had strengths and limitations in the effectiveness in providing positive impact towards the obese population of Australia. Obesity presents a considerable risk to Australian people with the aetiology being multifactorial which include socioeconomic background, hormonal, and environmental differences which both provide some (Meleady, 2018). According to (Lavie et al., 2014), limiting excessive weight gain and the contributing factors should develop strategies that are population-based and education to help decrease health determinants such as obesity and the co-morbidities associated with obesity such as chronic diseases. The 5-star rating scale of the HSR framework provided beneficial information, but also some negative influence with suggestions of confusion with the way the ratings were delivered (OPC, 2018). The AHWG provided support through an interactive website which encourages individual behaviour change and education on making healthy options such as fruit and vegetable intake, less high energy dense foods, and an exercise program journal (DOH, 2014). This encourages individuals to make a change in a positive way and encourage geting engaged in an active lifestyle (Lavie et al., 2014).

Despite all the education and guidelines that are readily available to the obese population, research suggests that the major factors in reducing excessive weight is through purely changing individual behaviours in lifestyle ways which include: changing diet, becoming engaged in physical activity, and motivation, all of which is cited that the drive for losing weight was becoming thin is intrinsically (Russo et al., 2011). Policies that change the environment, in which, make it easier to live inactive lifestyles through consumption of nutrient void food and lack of exercise, do not focus on real time, present environment (Teixeira et al., 2012). This would suggest adopting the self-determination theory and that more emphasis should be made through individual interventions such as intrinsic motivation, personal goals, and personal attitudes with less emphasis on whole population policies (Teixeira et al., 2012). The drive for being thin is an intrinsic motivation and self-determination that is within an individual, if intrinsic motivation or self-determination is not present, an individual will not fully commit to a behaviour change (Russo et al., 2011). Following the self-determination theory which is allowing autonomy be the central focus to pursing goals, which allows distinguishing factors such as personal goals to sustain high levels of self-esteem (Teixeira et al., 2012). This suggests that policy change alone will not see a significant improvement in the obesity rates, but through a combination of individual changes and policy will enable positive behavioural change (Lavie et al., 2014). This includes increasing activity, limiting unhealthy food advertising, making the healthy choice, and less sedentary activities (Lavie et al., 2014). Although, this is a downstream outlook on health, for an individual to make the necessary changes towards negative behaviour, intrinsic motivation, self-determination, and perseverance will unlock long term positive behaviour change in obese people (Russo et al., 2011; Teixeira et al., 2012).

Conclusion.

In conclusion, the rise in obesity is alarming and concerning in Australia. Both policy and behaviour changing interventions are necessary to engage in decreasing obesity rate and reversing the negative behaviours of people. The rise of obesity ensures that policies and guidelines are to be implemented to amend the burden obesity presents with the HSR framework and the AHWG interactive website helping lessen that burden, somewhat. Reversing the trend of obesity is needed in future intervention and policies with targeting socio-economic and population-based changes make improvements, but also provide overall awareness on the increasing risks of obesity. However, challenges still arise for both policies and behaviour changing interventions with the perseverance and motivation of an individual still providing the major link in changing negative change into a positive change. Through long-term strategic frameworks coupled with promoting individual behaviour changes through motivation and self-determination, will support the decrease in the increasing obesity rate of Australian adults and provide a healthier life for Australian people.

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